Development and statistical assessment of a paper-based immunoassay for detection of tumor markers

A novel portable immuno-device for the recognition of lymphatic vessel endothelial hyaluronan receptor-1 biomarker using GQD-AgNPrs conductive ink stabilized on the surface of cellulose

Lymphatic vessel endothelium expresses various lymphatic marker molecules. LYVE-1, the lymphatic vessel endothelial hyaluronan (HA) receptor, a 322-residue protein belonging to the integral membrane glycoproteins which is found on lymph vessel wall and is completely absent from blood vessels. LYVE-1 is very effective in the passage of lymphocytes and tumor cells into the lymphatics. As regards cancer metastasis, in vitro studies indicate LYVE-1 to be involved in tumor cell adhesion. Researches show that, in neoplastic tissue, LYVE-1 is limited to the lymphovascular and could well be proper for studies of tumor lymphangiogenesis. So, the monitoring of LYVE-1 level in human biofluids has provided a valuable approach for research into tumor lymphangiogenesis. For the first time, an innovative paper-based electrochemical immune-platform was developed for recognition of LYVE-1. For this purpose, graphene quantum dots decorated silver nanoparticles nano-ink was synthesized and designed directly by writing pen-on paper technology on the surface of photographic paper. This nano-ink has a great surface area for biomarker immobilization. The prepared paper-based biosensor was so small and cheap and also has high stability and sensitivity. For the first time, biotinylated antibody of biomarker (LYVE-1) was immobilized on the surface of working electrode and utilized for the monitoring of specific antigen by simple immune-assay strategy. The designed biosensor showed two separated linear ranges in the range of 20-320 pg ml-1 and 0.625-10 pg ml-1, with the acceptable limit of detection (LOD) of 0.312 pg ml-1. Additionally, engineered immunosensor revealed excellent selectivity that promises its use in complex biological samples and assistance for biomarker-related disease screening in clinical studies.

Smart sampling as the "Spot-on" Method for LC-MS protein analysis from dried blood spots

This perspective explores the feasibility of smart sampling with dried blood spots for the determination of proteins and peptides from human biomatrices using liquid chromatography coupled to mass spectrometry for clinical purposes. The focus is on innovative approaches to transform filter paper from a mere sample carrier to an active element in sample preparation, with the aim of reducing the need for extensive and intensive sample preparation in the conventional sense. Specifically, we discuss the use of modified cellulose to integrate sample preparation at an early stage of sample handling. The use of paper immobilized with either trypsin or monoclonal antibodies for protein digestion and affinity clean-up is discussed as a potential benefit of starting sample preparation instantly at the moment of sampling to optimize time efficiency and enable faster analysis, diagnosis, and follow-up of patients.

A Nitrocellulose Paper-Based Multi-Well Plate for Point-of-Care ELISA

Low-cost diagnostic tools for point-of-care immunoassays, such as the paper-based enzyme-linked immunoassay (ELISA), have become increasingly important, especially so in the recent COVID-19 pandemic. ELISA is the gold-standard antibody/antigen sensing method. This paper reports an easy-to-fabricate nitrocellulose (NC) paper plate, coupled with a desktop scanner for ELISA, which provides a higher protein immobilization efficiency than the conventional cellulose paper-based ELISA platforms. The experiments were performed using spiked samples for the direct ELISA of rabbit IgG with a limit of detection (LOD) of 1.016 μg/mL, in a measurement range of 10 ng/mL to 1 mg/mL, and for the sandwich ELISA of sperm protein (SP-10) with an LOD of 88.8 ng/mL, in a measurement range of 1 ng/mL to 100 μg/mL. The described fabrication method, based on laser-cutting, is a highly flexible one-step laser micromachining process, which enables the rapid production of low-cost NC paper-based multi-well plates with different sizes for the ELISA measurements.

Ultrasensitive detection of β-lactamase-associated drug-resistant bacteria using a novel mass-tagged probe-mediated cascaded signal amplification strategy

The emergence and spread of drug-resistant bacteria (DRB) is a global health threat. Early and accurate detection of DRB is a critical step in the treatment of DRB infection. However, traditional assays for DRB detection are time-consuming and have inferior analytical sensitivity and quantification capability. Herein, a mass-tagged probe (MP-CMSA)-mediated enzyme- and light-assisted cascaded signal amplification strategy was developed for the ultrasensitive detection of β-lactamase (BLA), an enzyme closely associated with most DRB. Each MP-CMSA probe contained multiple poly(amidoamine) (PAMAM) dendrimer molecules immobilized on a streptavidin agarose bead via a BLA-cleavable linker, and each dendrimer was modified with multiple mass tags via a photo-cleavable linker. In BLA detection, BLA could cleave the BLA-cleavable linker, leading to dendrimers shedding from the MP-CMSA probe to achieve enzyme-assisted signal amplification. Then, each dendrimer can further release mass tags under UV light to achieve light-assisted signal amplification. After this cascaded signal amplification, the released mass tags were ultimately quantified by mass spectrometry. Consequently, the sensitivity of BLA detection can be significantly enhanced by four orders of magnitude with a detection limit of 50.0 fM. Finally, this approach was applied to the blood samples from patients with DRB. This platform provides a potential strategy for the sensitive, rapid and quantitative detection of DRB infection.

Role of Paper-Based Sensors in Fight against Cancer for the Developing World

Cancer is one of the major killers across the globe. According to the WHO, more than 10 million people succumbed to cancer in the year 2020 alone. The early detection of cancer is key to reducing the mortality rate. In low- and medium-income countries, the screening facilities are limited due to a scarcity of resources and equipment. Paper-based microfluidics provide a platform for a low-cost, biodegradable micro-total analysis system (µTAS) that can be used for the detection of critical biomarkers for cancer screening. This work aims to review and provide a perspective on various available paper-based methods for cancer screening. The work includes an overview of paper-based sensors, the analytes that can be detected and the detection, and readout methods used.

Evaluation of the fluorescent-thin layer chromatography (f-TLC) for the diagnosis of Buruli ulcer disease in Ghana

Background

Buruli ulcer is a tissue necrosis infection caused by an environmental mycobacterium called Mycobacterium ulcerans (MU). The disease is most prevalent in rural areas with the highest rates in West and Central African countries. The bacterium produces a toxin called mycolactone which can lead to the destruction of the skin, resulting in incapacitating deformities with an enormous economic and social burden on patients and their caregivers. Even though there is an effective antibiotic treatment for BU, the control and management rely on early case detection and rapid diagnosis to avert morbidities. The diagnosis of Mycobacterium ulcerans relies on smear microscopy, culture histopathology, and PCR. Unfortunately, all the current laboratory diagnostics have various limitations and are not available in endemic communities. Consequently, there is a need for a rapid diagnostic tool for use at the community health centre level to enable diagnosis and confirmation of suspected cases for early treatment. The present study corroborated the diagnostic performance and utility of fluorescent-thin layer chromatography (f-TLC) for the diagnosis of Buruli ulcer.

Methodology/Principal findings

The f-TLC method was evaluated for the diagnosis of Buruli ulcer in larger clinical samples than previously reported in an earlier preliminary study Wadagni et al. (2015). A total of 449 patients suspected of BU were included in the final data analysis out of which 122 (27.2%) were positive by f-TLC and 128 (28.5%) by PCR. Using a composite reference method generated from the two diagnostic methods, 85 (18.9%) patients were found to be truly infected with M. ulcerans, 284 (63.3%) were uninfected, while 80 (17.8%) were misidentified as infected or noninfected by the two methods. The data obtained was used to determine the discriminatory accuracy of the f-TLC against the gold standard IS2404 PCR through the analysis of its sensitivity, specificity, positive (+LR), and negative (–LR) likelihood ratio. The positive (PPV) and negative (NPV) predictive values, area under the receiver operating characteristic curve Azevedo et al. (2014), and diagnostic odds ratio were used to assess the predictive accuracy of the f-TLC method. The sensitivity of f-TLC was 66.4% (85/128), specificity was 88.5% (284/321), while the diagnostic accuracy was 82.2% (369/449). The AUC stood at 0.774 while the PPV, NPV, +LR, and–LR were 69.7% (85/122), 86.9% (284/327), 5.76, and 0.38, respectively. The use of the rule-of-thumb interpretation of diagnostic tests suggests that the method is good for use as a diagnostic tool.

Conclusions/Significance

Larger clinical samples than previously reported had been used to evaluate the f-TLC method for the diagnosis of Buruli ulcer. A sensitivity of 66.4%, a specificity of 88.5%, and diagnostic accuracy of 82.2% were obtained. The method is good for diagnosis and will help in making early clinical decisions about the patients as well as patient management and facilitating treatment decisions. However, it requires a slight modification to address the challenge of background interference and lack of automatic readout to become an excellent diagnostic tool.

Colorimetric Paper-Based Sensors against Cancer Biomarkers

Cancer is a major cause of mortality and morbidity worldwide. Detection and quantification of cancer biomarkers plays a critical role in cancer early diagnosis, screening, and treatment. Clinicians, particularly in developing countries, deal with high costs and limited resources for diagnostic systems. Using low-cost substrates to develop sensor devices could be very helpful. The interest in paper-based sensors with colorimetric detection increased exponentially in the last decade as they meet the criteria for point-of-care (PoC) devices. Cellulose and different nanomaterials have been used as substrate and colorimetric probes, respectively, for these types of devices in their different designs as spot tests, lateral-flow assays, dipsticks, and microfluidic paper-based devices (μPADs), offering low-cost and disposable devices. However, the main challenge with these devices is their low sensitivity and lack of efficiency in performing quantitative measurements. This review includes an overview of the use of paper for the development of sensing devices focusing on colorimetric detection and their application to cancer biomarkers. We highlight recent works reporting the use of paper in the development of colorimetric sensors for cancer biomarkers, such as proteins, nucleic acids, and others. Finally, we discuss the main advantages of these types of devices and highlight their major pitfalls.

Designing of a pH-activatable carbon dots as a luminescent nanoprobe for recognizing folate receptor-positive cancer cells

During recent years, cancer has been recognized as a well-known disorder all over the world. One of the important factors to tackle this problem better than past decades is early diagnosis that takes into practice by state-of-the-art visual equipment for detection cancer cells. Herein, in this research, we synthesized carbon dots with pH-dependent behavior from a green source by hydrothermal method with high quantum yield and blue fluorescence. Folic acid-conjugated carbon dots by an efficient and optimal conjugation method were set upped which determined cancer cells visually. These synthesized and conjugated nanoparticles entered into the cancer cells more comprehensive than normal cells by receptor-mediated endocytosis and could distinguish cancer cells from normal ones by fluorescence imaging. Ultimately, synthesized nanoparticles in this research can be considered as an efficient fluorescent nanoprobe for cancer pre-diagnosis.

In vivo study of a novel, safe, rapid, and targeted red carbon dot probe for recognition of tumors with high expression of folate enzyme

Carbon dots (CDS) have been proved to be a type of ideal biological imaging probe. They have the advantages of spontaneous fluorescence, anti-photobleaching, good biocompatibility and easy surface decoration, and are receiving special attention from researchers. The early imaging diagnosis of tumors has always been a practical means of clinical diagnosis. Finding an efficient and low-toxicity tumor probe is the continuous goal of tumor clinical diagnosis and treatment. Therefore, this article uses the modifiable properties of the surface structure of carbon dots, and at the same time, uses the characteristics of tumors with high expression of folate receptors (FR) that can specifically take up folic acid (FA) to construct folic acid carbon dot conjugates (FA–CDs) to achieve targeted tumor uptake. Firstly, CCK8 toxicity tests proved that FA–DCCDs had good biocompatibility and were almost non-toxic. Further, confocal cell imaging experiments, microplate quantitative experiments and flow cytometry experiments proved that FA–CDs were selective and more easily absorbed by tumor cells with high expression of folate receptors, and bare carbon dots could be absorbed into cells without selectivity. Through in vivo experiments, the law of injection of bare CDs into the body was explored, which proved that they had no obvious accumulation and had high distribution in the liver and kidneys. FA–CDs was applied to the targeted imaging of a mouse tumor model in vivo for the first time, which proved again that the carbon point coupled with folic acid had selectivity for tumor cells with high expression of FR receptors, which provided a basis for tumor drug research and early clinical diagnosis of tumors.

Carbon dots (CDS) have been proved to be a type of ideal biological imaging probe.

Recent advances in lab-on-paper diagnostic devices using blood samples

Lab-on-paper, or microfluidic paper-based analytical devices (μPADs), use paper as a substrate material, and are patterned with a system of microchannels, reaction zones and sensing elements to perform analysis and detection. The sample transfer in such devices is performed by capillary action. As a result, external driving forces are not required, and hence the size and cost of the device are significantly reduced. Lab-on-paper devices have thus attracted significant attention for point-of-care medical diagnostic purposes in recent years, particularly in less-developed regions of the world lacking medical resources and infrastructures. This review discusses the major advances in lab-on-paper technology for blood analysis and diagnosis in the past five years. The review focuses particularly on the many clinical applications of lab-on-paper devices, including diabetes diagnosis, acute myocardial infarction (AMI) detection, kidney function diagnosis, liver function diagnosis, cholesterol and triglyceride (TG) analysis, sickle-cell disease (SCD) and phenylketonuria (PKU) analysis, virus analysis, C-reactive protein (CRP) analysis, blood ion analysis, cancer factor analysis, and drug analysis. The review commences by introducing the basic transmission principles, fabrication methods, structural characteristics, detection techniques, and sample pretreatment process of modern lab-on-paper devices. A comprehensive review of the most recent applications of lab-on-paper devices to the diagnosis of common human diseases using blood samples is then presented. The review concludes with a brief summary of the main challenges and opportunities facing the lab-on-paper technology field in the coming years.

The impact of grey zones on the accuracy of agreement measures for ordinal tables

Background

In an inter-rater agreement study, if two raters tend to rate considering different aspects of the subject of interest or have different experience levels, a grey zone occurs among the levels of a square contingency table showing the inter-rater agreement. These grey zones distort the degree of agreement between raters and negatively impact the decisions based on the inter-rater agreement tables. In this sense, it is important to know how the existence of a grey zone impacts the inter-rater agreement coefficients to choose the most reliable agreement coefficient against the grey zones to reach out with more reliable decisions.

Methods

In this article, we propose two approaches to create grey zones in simulations setting and conduct an extensive Monte Carlo simulation study to figure out the impact of having grey zones on the weighted inter-rater agreement measures for ordinal tables over a comprehensive simulation space.

Results

The weighted inter-rater agreement coefficients are not reliable against the existence of grey zones. Increasing sample size and the number of categories in the agreement table decreases the accuracy of weighted inter-rater agreement measures when there is a grey zone. When the degree of agreement between the raters is high, the agreement measures are not significantly impacted by the existence of grey zones. However, if there is a medium to low degree of inter-rater agreement, all the weighted coefficients are more or less impacted.

Conclusions

It is observed in this study that the existence of grey zones has a significant negative impact on the accuracy of agreement measures especially for a low degree of true agreement and high sample and tables sizes. In general, Gwet’s AC2 and Brennan-Prediger’s κ with quadratic or ordinal weights are reliable against the grey zones.

Supplementary Information

The online version contains supplementary material available at (10.1186/s12874-021-01248-3).

Molecularly imprinted polymer-enhanced biomimetic paper-based analytical devices: A review

The popularization of paper-based analytical devices (PADs) in analytical science has fostered research on enhancing their analytical performance for accurate and sensitive assays. With their superb recognition capability and structural stability, molecularly imprinted polymers (MIPs) have been extensively employed as biomimetic receptors for capturing target analytes in various complex matrices. The integration of MIPs as recognition elements with PADs (MIP-PADs) has opened new opportunities for advanced analytical devices with elevated selectivity and sensitivity, as well as a shorter assay time and a lower cost. This review covers recent advances in MIP-PAD fabrication and engineering based on multifarious signal transduction systems such as colorimetry, fluorescence, electrochemistry, photoelectrochemistry, and chemiluminescence. The application of MIP-PADs in the fields of biomedical diagnostics, environmental analysis, and food safety monitoring is also reviewed. Further, the advantages, challenges, and perspectives of MIP-PADs are discussed.

A novel immunosensor for the monitoring of PSA using binding of biotinylated antibody to the prostate specific antigen based on nano-ink modified flexible paper substrate: efficient method for diagnosis of cancer using biosensing technology

Prostate cancer is the most significant reason for deaths in men, outside of lung cancer. The clinical examination of cancer proteins or biomarkers is extremely significant in early examination and monitoring of recurrence of disease after treatment. Biomarkers have expanded great clinical significance owing to their extensive spectra in the identification, elimination, early diagnosis and cure of cancer. In this work, novel, ultrasensitive sandwich-type portable bio device based on citrate-capped silver nanoparticles (Citrate-AgNPs) modified graphene quantum dots (GQDs) nano ink for detection of Prostate specific antigen (PSA) was fabricated. Functionalized cysteamine with gold nanoparticles (Cys-AuNPs) was also utilized to amplify the signal. It provides a good and high external area for the immobilization biotinylated antibody of PSA in the large amount. For the first time, citrate-AgNPs-GQDs nano ink was directly written on the cellulose paper surface (ivory sheet and photographic paper) and modified by Cys-AuNPs. So, final structure of the immunodevices was completed after including of Ab1 and PSA (antigen). The immunosensors were used for the recognition of PSA by using DPVs (differential pulse voltammetry) technique. The obtained low limit of quantification (LLOQ) of the first immunodevice (ivory sheet/Citrate AgNPs-GQDs nano-ink/CysA-Au NPs/Ab1/BSA/PSA/Ab2) was 0.07 μg/L and the linear range for the calibration plot was from 0.07 to 60 μg/L. Also, the achieved LLOQ of the second immunodevice (photographic paper/Citrate AgNPs-GQDs nano-ink/Cys-Au NPs/Ab1/BSA/PSA/Ab2) was 0.05 μg/L with the linear range of 10 to 0.05 μg/L. It is noteworthy that, proposed immunoassay was effectively utilized to the monitoring of PSA glycoprotein in unprocessed human plasma sample. Obtained results show that the constructed immunosensor is able to apply as portable bio device for the clinical analysis of PSA in human plasma samples.

Smartphone-imaged multilayered paper-based analytical device for colorimetric analysis of carcinoembryonic antigen

Paper-based immunoassays are effective methods that employ microfluidic paper-based analytical devices (μPADs) for the rapid, simple, and accurate quantification of analytes in point-of-care diagnosis. In this study, we developed a wax-printed multilayered μPAD for the colorimetric detection of carcinoembryonic antigen (CEA), where the device contained a movable and rotatable detection layer to allow the μPAD to switch the state of the sample solutions, i.e., flowing or storing in the sensing zones. A smartphone with a custom-developed program served as an automated colorimetric reader to capture and analyze images from the μPAD, before calculating and displaying the test results. After optimizing the crucial conditions for the assay, the proposed method exhibited a wide linear dynamic range from 0.5 to 70 ng/mL, with a low CEA detection limit of 0.015 ng/mL. The clinical performance of this method was successfully validated using 50 positive and 40 negative human serum samples, thereby demonstrating the high sensitivity of 98.0% and specificity of 97.5% in the detection of CEA. The proposed method is greatly simplified compared with the cumbersome steps required for traditional immunoassays, but without any loss of accuracy and stability, as well as reducing the time needed to detect CEA. Complex and bulky instruments are replaced with a smartphone. The proposed detection platform could potentially be applied in point-of-care testing. Graphical abstract.

Enhanced Colorimetric Signal for Accurate Signal Detection in Paper-Based Biosensors

Paper-based colorimetric biosensors combine the use of paper with colorimetric signal detection. However, they usually demonstrate lower sensitivities because a signal amplification procedure has not been used. Stopping the reaction of colorimetric signal generation is often used in lab-based assays in order to amplify and stabilize the colorimetric signal for detection. In this study, the generation of a stopped colorimetric signal was examined for accurate and enhanced signal detection in paper-based biosensors. The colorimetric reaction in biosensors is usually based on the interaction between the enzyme horseradish peroxidase (HRP) and a selected chromogenic substrate. The two most commonly used HRP substrates, 3,3’,5,5’-tetramethylbenzidine (TMB) and 2’-azinobis (3-ethylbenzothiazoline-6-sulfonic-acid) (ABTS), were compared in terms of their ability to generate a stopped colorimetric signal on membrane. The stopped colorimetric signal was visible for TMB but not for ABTS. Moreover, the generation of stopped colorimetric signal was dependent on the presence of polyvinylidene-difluoride (PVDF) membrane as the separation layer. With PVDF the colorimetric signal (color intensity) was higher (TMB: 126 ± 6 and ABTS: 121 ± 9) in comparison to without PVDF (TMB: 110 ± 2 and ABTS: 102 ± 4). The TMB stopped colorimetric signal demonstrated a more stable signal detection with lower standard deviation values. To conclude, a stopped colorimetric signal can be generated in paper-based biosensors for enhanced and accurate signal detection.

Detection of the SARS-CoV-2 humanized antibody with paper-based ELISA

This work reports the development of a rapid, simple and inexpensive colorimetric paper-based assay for the detection of the severe acute respiratory symptom coronavirus 2 (SARS-CoV-2) humanized antibody.

Rapid, quantitative and ultra-sensitive detection of cancer biomarker by a SERRS-based lateral flow immunoassay using bovine serum albumin coated Au nanorods

A rapid, sensitive, and stable SERRS-LFIA strip was developed for AFP detection using BSA-coated AuNRs as SERRS nanotags.

Paper based immunosensing of ovarian cancer tumor protein CA 125 using novel nano-ink: A new platform for efficient diagnosis of cancer and biomedical analysis using microfluidic paper-based analytical devices (μPAD)

Ovarian cancer is the first and most important cause of malignancy death in women. Mucin 16 or MUC16 protein also known as carcinoma antigen 125 (CA 125) is the most commonly used glycoprotein for early stage diagnosis of ovarian cancer. In this work, a novel paper-based bio-device through hand writing of Ag/RGO (silver nanoparticles/reduced graphene oxide) nano-ink on the flexible paper substrate using pen-on-paper technology was developed. The prepared interface was used to the recognition of CA 125 protein in human biofluid. For this purpose, Ag/rGO nano-ink was synthesized by deposition of Ag nanoparticles onto graphene oxide sheets and the reduction of graphene oxide to rGO simultaneously. Conductivity and resistance of conductive lines were studied after drawing on photographic paper. Subsequently, to prepare a new and unique immuno-device, paper electrode modified by cysteamine caped gold nanoparticles (CysA/Au NPs) using electrochemical techniques. CysA is bonded by sulfur atoms with Au (CysA/Au NPs), and from the amine group with hydroxyl and carboxyl groups of Ag/RGO nano-ink deposited on the surface of paper-based electrodes (CysA/Au NPs/Ag-rGO). Then, anti-CA 125 antibody was immobilized on the electrode surface through Au NPs and CA 125 positively charged amine groups interaction. Atomic force microscopy, Transmission electron microscopy, Field emission scanning electron microscopy, and dynamic light scattering, were performed to identify the engineered immunosensor. Using chronoamperometry technique and under the optimized conditions, the low limit of quantitation (LLOQ) for the proposed immunoassay was recorded as 0.78 U/ml, which this evaluation was performed at highly linear range of 0.78-400 U/ml. The high sensitivity of the electrochemical immunosensor device is indicative of the ability of this immuno-device to detect early stages ovarian cancer.

Label-free microfluidic paper-based electrochemical aptasensor for ultrasensitive and simultaneous multiplexed detection of cancer biomarkers

Simultaneous detection of multiple tumor biomarkers in body fluids could facilitate early diagnosis of lung cancer, so as to provide scientific reference for clinical treatment. This paper depicted a multi-parameter paper-based electrochemical aptasensor for simultaneous detection of carcinoembryonic antigen (CEA) and neuron-specific enolase (NSE) in a clinical sample with high sensitivity and specificity. The paper-based device was fabricated through wax printing and screen-printing, which enabled functions of sample filtration and sample auto injection. Amino functional graphene (NG)-Thionin (THI)- gold nanoparticles (AuNPs) and Prussian blue (PB)- poly (3,4- ethylenedioxythiophene) (PEDOT)- AuNPs nanocomposites were synthesized respectively. They were used to modify the working electrodes not only for promoting the electron transfer rate, but also for immobilization of the CEA and NSE aptamers. A label-free electrochemical method was adopted, enabling a rapid simple point-of-care testing. Experimental results showed that the proposed multi-parameter aptasensor exhibited good linearity in ranges of 0.01-500 ng mL^-1 for CEA (R² = 0.989) and 0.05-500 ng mL^-1 for NSE (R² = 0.944), respectively. The limit of detection (LOD) was 2 pg mL^-1 for CEA and 10 pg mL^-1 for NSE. In addition, the device was evaluated using clinical serum samples and received a good correlation with large electrochemical luminescence (ECL) equipment, which would offer a new platform for early cancer diagnostics, especially in those resource-limit areas.

Folic acid-conjugated green luminescent carbon dots as a nanoprobe for identifying folate receptor-positive cancer cells

Early diagnosis is pivotal in subsequent prognosis and treatment of cancer. Herein, folic acid-conjugated carbon dots (FA-CDs) as a fluorescent nanoprobe were fabricated for identifying cancer cells visually. Green luminescent carbon dots (CDs) from active dry yeast (ADY) were readily prepared in scale-up to reach macroscopic production with a high yield of ~50% via a facile and rapid microwave approach. The as-prepared CDs were further combined with folic acid (FA) by covalent bonding to fabricate the FA-CDs for identification of cancer cells over-expressing folate receptor (FR). Experimental outcomes demonstrated that the resultant FA-CDs noninvasively entered into cancer cells via receptor-mediated endocytosis and could differentiate FR-positive HepG2 cells from a cell mixture by fluorescence imaging, which suggests a promising prospect of the FA-CDs as an efficient probe for cancer diagnosis and succeeding personalized therapy.

Aptamer induced multicoloured Au NCs-MoS2 "switch on" fluorescence resonance energy transfer biosensor for dual color simultaneous detection of multiple tumor markers by single wavelength excitation

An aptamer induced "switch on" fluorescence resonance energy transfer (FRET) biosensor for the simultaneous detection of multiple tumor markers (e.g., AFP and CEA) combining molybdenum disulfide (MoS₂) nanosheets with multicolored Au NCs by a single excitation was developed for the first time. Here, AFP aptamer functionalized green colored Au NCs (510 nm) and CEA aptamer functionalized red colored Au NCs (650 nm) are used as energy donors, while MoS₂ is used as energy receptor. On the basis of recording the change of the recovered fluorescence intensity at 510 nm and 650 nm upon the addition of targets CEA and AFP, these two tumor markers can be simultaneously quantitatively detected, with detection limits of 0.16 and 0.21 ng mL^-1 (3σ) for AFP and CEA, respectively. In addition, it is noteworthy that the developed biosensor can not only realize accurate quantitative determination of multiple tumor markers by fluorescent intensity, but also be applied in semi-quantitative determination through photo visualization. More importantly, confocal microscope experiments prove that serums from normal and hepatoma patients can also be visually and qualitatively discriminated by this FRET-based biosensor with a single excitation wavelength, indicating promising potential of this assay for clinical diagnosis.

Sensitivity, Specificity, Predictive Values, and Accuracy of Three Diagnostic Tests to Predict Inferior Alveolar Nerve Blockade Failure in Symptomatic Irreversible Pulpitis

INTRODUCTION

The inferior alveolar nerve block (IANB) is the most common anesthetic technique used on mandibular teeth during root canal treatment. Its success in the presence of preoperative inflammation is still controversial. The aim of this study was to evaluate the sensitivity, specificity, predictive values, and accuracy of three diagnostic tests used to predict IANB failure in symptomatic irreversible pulpitis (SIP).

METHODOLOGY

A cross-sectional study was carried out on the mandibular molars of 53 patients with SIP. All patients received a single cartridge of mepivacaine 2% with 1 : 100000 epinephrine using the IANB technique. Three diagnostic clinical tests were performed to detect anesthetic failure. Anesthetic failure was defined as a positive painful response to any of the three tests. Sensitivity, specificity, predictive values, accuracy, and ROC curves were calculated and compared and significant differences were analyzed.

RESULTS

IANB failure was determined in 71.7% of the patients. The sensitivity scores for the three tests (lip numbness, the cold stimuli test, and responsiveness during endodontic access) were 0.03, 0.35, and 0.55, respectively, and the specificity score was determined as 1 for all of the tests. Clinically, none of the evaluated tests demonstrated a high enough accuracy (0.30, 0.53, and 0.68 for lip numbness, the cold stimuli test, and responsiveness during endodontic access, resp.). A comparison of the areas under the curve in the ROC analyses showed statistically significant differences between the three tests (p < 0.05).

CONCLUSION

None of the analyzed tests demonstrated a high enough accuracy to be considered a reliable diagnostic tool for the prediction of anesthetic failure.

Technical aspects and challenges of colorimetric detection with microfluidic paper-based analytical devices (μPADs) - A review

Paper-based devices are a leading alternative among the main analytical tools for point-of-care testing, due to their portability, low-cost, and ease-of-use. Colorimetric readouts are the most common method of detection in these microfluidic devices, enabling qualitative, semi-quantitative and fully quantitative analysis of multiple analytes. There is a multitude of ways to obtain a colorimetric output in such devices, including nanoparticles, dyes, redox and pH indicators, and each has unique drawbacks and benefits. There are also multiple variables that impact the analysis of colorimetric reactions in microfluidic paper-based systems, including color homogeneity, image capture methods, and the data handling itself. Here, we present a critical review of recent developments and challenges of colorimetric detection on microfluidic paper-based analytical devices (μPADs), and present thoughts and insights towards future perspectives in the area to improve the use of colorimetric readouts in conjunction with μPADs.